Provider Demographics
NPI:1255335782
Name:REYNOLDS, JARRELL PAUL (MD)
Entity type:Individual
Prefix:
First Name:JARRELL
Middle Name:PAUL
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-0312
Mailing Address - Country:US
Mailing Address - Phone:325-625-3533
Mailing Address - Fax:325-625-3477
Practice Address - Street 1:310 S PECOS ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-4159
Practice Address - Country:US
Practice Address - Phone:325-625-3533
Practice Address - Fax:325-625-3477
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-03-25
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
TXH0755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138941307Medicaid
TX138941312Medicaid
TX138941307Medicaid
TX138941312Medicaid